Cryotherapy involves applying cold to the body for therapeutic purposes. Various techniques are used including ice massage, ice towels, cold whirlpools, ice packs, and vapocoolant sprays. Physiological effects include initial decreased blood flow followed by increased blood flow, decreased nerve conduction velocity, and altered muscle strength. Cold therapy is used to treat conditions like ankle sprains and muscle contusions by reducing swelling and pain. Contraindications include cardiac conditions, peripheral nerve injuries, and peripheral vascular disease as cold can further reduce blood flow.

1. CRYOTHERAPY
-BY
ANNIE BLESSIE
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2. CONTENTS :
• INTRODUCTION
• APPLICATION OF TECHNIQUES
• PRINCIPLES
• PHYSIOLOGICAL AND THERAPEUTIC EFFECT
• DANGERS AND CONTRAINDICATIONS
• INDICATIONS 06-08-2020anniet250999@gmail.com 2

3. INTRODUCTION
• THE APPLICATION OF COLD FOR VARIOUS THERAPEUTIC PURPOSES IS CALLED CRYOTHERAPY.
• CRYOTHERAPY IS COMMONLY USED IN THE TREATMENT OF ACUTE TRAUMA AND SUBACUTE INJURY.
• THE TEMPERATURE OF THE BODY TISSUE IS REDUCED AND THE HEAT IS TRANSFERRED FROM THE BODY
TISSUE TO THE COLD MEDIUM.
• THE DEPTH OF PENETRATION IS ALSO RELATED TO INTENSITY AND DURATION OF COLD APPLICATION
AND THE CIRCULATORY RESPONSE TO THE BODY SEGMENT EXPOSED.
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4. Temperature of tissues depend upon :
1. The temperature difference between the coolant and the tissues: the colder the application, the
greater the heat loss from the tissues.
2. The thermal conductivity of the tissues: This differs from one area to another. In general, water-filled
tissues, such as muscles, have a high thermal conductivity as compared to fat or skin. The normal layer
of subcutaneous fat serves as a thermal insulation for the inner tissues so that the heat loss through the
tissues and the cold penetration is largely dependent upon the blood flow.
3. The length of time for which the cold is applied: The amount of energy loss is fully dependent upon
the length of exposure.
4. The size of area that is being cooled
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5. APPLICATION OF TECHNIQUES
THE VARIOUS TECHNIQUES THAT ARE USED FOR ADMINISTERING COLD ARE:
• ICE MASSAGE
• ICE TOWELS
• IMMERSION IN COLD OR COLD WHIRLPOOL
• ICE PACKS OR COLD PACKS
• EVAPORATIVE COOLING OR VAPOCOOLANT SPRAYS
• EXCITATORY COLD. 06-08-2020anniet250999@gmail.com 5

6. ICE MASSAGE
IN THIS TECHNIQUE ICE IS PLACED IN A
POLYTHENE BAG AND APPLIED OVER
THE BODY TISSUE. ICE CUBES, CRUSHED
ICE OR FLAKED ICE, ETC. CAN BE USED.
THE ICE BAG IS PLACED OVER THE
PATIENT’S TISSUE AND THE PATIENT IS
NOT ALLOWED TO LIE OVER THE PACK.
THE PRESSURE OF APPLICATION SHOULD
BE MINIMAL AND THE MOVEMENT OF
THE BAG SHOULD BE TO AND FRO AND
CIRCULAR.
THE ICE CAN BE PLACED OVER THE
BODY TISSUE FOR A PERIOD OF 10–20
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7. ICE
TOWELS
THIS IS A POPULAR METHOD OF
APPLICATION BECAUSE THERE IS LITTLE
DANGER OF PRODUCING AN ICE BURN.
PREPARE THE ICE SOLUTION BY FILLING A
BUCKET OR BOWL WITH TWO PARTS OF
FLAKED OR CRUSHED ICE TO ONE PART
WATER IN WHICH TWO TERRY TOWELS ARE
IMMERSED. THE SURPLUS WATER IS WRUNG
FROM TOWEL, LEAVING AS MUCH ICE
CLINGING TO IT AS POSSIBLE. IT IS THEN
APPLIED TO THE PART BEING TREATED. THE
TOWELS ARE CHANGED AFTER EVERY 30
SECONDS TO 2 MINUTES. UPTO TEN TOWELS
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8. COLD
WHIRLPOOL
THE PART OF THE BODY IS IMMERSED IN COLD WATER OR A
WHIRLPOOL IN WHICH TEMPERATURE OF WATER IS LOWERED
UP TO 0–10ºC.
FLAKED ICE OR CRUSHED ICE IS USED IN A SOLUTION WITH
WATER TO FORM SLUSH.
EXTREMITIES OF THE BODY CAN BE EFFECTIVELY TREATED
WITH IMMERSION IN THE COLD.
THE TOTAL DURATION OF THE TREATMENT IS AROUND 10
MINUTES IN WHICH THE PATIENT CAN IMMERSE IN EITHER
FOR A SINGLE 10 MINUTES SESSION OR FOR A SERIES OF
SHORTER IMMERSIONS UNTIL ACCUMULATIVE TOTAL OF 10
MINUTES HAVE BEEN REACHED 06-08-2020anniet250999@gmail.com 8

9. ICE
PACK
THESE COLD PACKS CONTAIN SPECIAL MATERIAL
WHICH RETAINS THE COLD LIKE THE SILICATE GEL.
THESE ARE AVAILABLE IN VARIOUS SIZES AND
SHAPES. DIFFERENT BODY PARTS ARE TREATED WITH
DIFFERENT SIZES AND SHAPES OF COLD PACKS .
THESE PACKS ARE STORED IN A SPECIAL
REFRIGERATION OR FREEZER FOR AT LEAST 20
MINUTES TO 1 HOUR BEFORE USE .
THE MAIN ADVANTAGE OF THESE COLD PACKS ARE
THAT THEY ARE REUSABLE AND CAN CONTOUR OR
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10. VAPOCOOLANT
SPRAY
THE USE OF VAPOCOOLANT SPRAYS ARE INCREASING .
THESE ARE BEING USED VERY COMMONLY IN SPORTING
ACTIVITIES OR ATHLETIC INJURIES.
THE COMMONLY USED SPRAYS ARE FLUOROMETHANE
OR ETHYL CHLORIDE.
THE JET OF SPRAY IS USUALLY APPLIED FROM A
DISTANCE OF ABOUT 1 FEET OR 12 INCHES.
GENTLE STRETCH IS APPLIED TO THE TISSUES AFTER
APPLICATION OF VAPOCOOLANT SPRAYS.
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11. EXCITATORY
COLD
THE ICE IS STROKED QUICKLY THREE TIMES OVER THE DERMATOME AND SKIN IS
THEN DRIED.
THIS SENSORY STIMULUS PASSES VIA THE PERIPHERAL NERVE AND ENTERS THE
CORD THROUGH POSTERIOR HORN.
IT RAISES THE LEVEL OF EXCITATION AROUND THE ANTERIOR HORN CELL .
THE INCREASED EXCITATION MAY SUPPLEMENT THE PATIENT’S WILLING EFFORT
TO MAKE THE MUSCLE CONTRACT.
THIS TECHNIQUE OF ‘QUICK ICE’ IS OFTEN A USEFUL STIMULUS IN AIDING
VOLUNTARY CONTRACTION OF MUSCLE.
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12. PRINCIPLES :
• WHEN COLD THERAPY IS APPLIED TO THE TISSUES, THE HEAT IS ABSORBED FROM THE TISSUES
BY THE COOLING AGENT. ICE CHANGES ITS STATE FROM SOLID TO LIQUID BY ABSORBING HEAT. A
SPECIFIC AMOUNT OF ENERGY IS REQUIRED TO CHANGE THE SOLID FORM OF ICE INTO WATER
WHICH IS CALLED LATENT HEAT OF FUSION.
• THUS, FOR COOLING THE BODY TISSUES IT IS BETTER TO USE ICE FOR TREATMENT RATHER THAN
WATER.
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13. PHYSIOLOGICAL AND THERAPEUTIC
EFFECTS
 HEMODYNAMIC EFFECTS
. INITIAL DECREASE IN BLOOD FLOW
. LATER INCREASE IN BLOOD FLOW
 NEUROMUSCULAR EFFECTS
.DECREASED NERVE CONDUCTION VELOCITY
. INCREASED PAIN THRESHOLD
. ALTERED MUSCLE STRENGTH
DECREASED SPASTICITY
FACILITATION OF MUSCLE CONTRACTION
 METABOLIC EFFECTS
. DECREASED METABOLIC RATE 06-08-2020anniet250999@gmail.com 13

14. DANGERS AND CONTRAINDICATION
• 1. CARDIAC CONDITIONS : IN PATIENT WITH A RECENT MYOCARDIAL INFARCTION, THE
APPLICATION OF COLD MAY CAUSE FURTHER DROP IN BLOOD PRESSURE AND FURTHER
REDUCES THE BLOOD SUPPLY OF THE HEART. THE WEAK HEART MAY COLLAPSE
IMMEDIATELY.
• 2. PERIPHERAL NERVE INJURIES : THE BLOOD SUPPLY OF THE PERIPHERAL NERVES REDUCES
FURTHER AND MAY CAUSE ITS FURTHER DAMAGE. ALSO, THE NERVE SUPPLY OF THE BLOOD
VESSELS IS FURTHER DELAYED CAUSING LOSS OF THE NORMAL RESPONSE OF ITS COOLING.
• 3. PERIPHERAL VASCULAR DISEASE : AS THE COLD MAY FURTHER REDUCE AN ALREADY
INADEQUATE BLOOD SUPPLY. IN CASES OF VASOSPASTIC DISEASE LIKE THE RAYNAUD’S
DISEASE, THE CONDITION MAY WORSEN BY THE APPLICATION OF COLD.
• 4. PSYCHOLOGICAL OR COLD SENSITIVE: THE PATIENTS HAVING FEAR OF THE COLD MAY
REACT ADVERSELY. THEY START PRODUCING HISTAMINE LIKE SUBSTANCE CAUSING
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15. INDICATIONS
ANKLE SPRAIN
• ANKLE SPRAIN IS THE MOST COMMON
OF ALL THE SPRAINS. LATERAL
LIGAMENT SPRAIN ACCOUNTS FOR
85% OF ALL ANKLE SPRAINS.
MUSCLE CONTUSION
• VERY COMMON IN CONTACT SPORTS,
CAUSE OF INJURY IS DIRECT BLOW OR
HIT BY A BLUNT OBJECT OR BY A
BALL. HEMATOMA OCCURS WHEN A
LARGE SIZED VESSEL IS DAMAGED
AND BLOOD STARTS ACCUMULATING
IN THE AREA.
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16. ANKLE
SPRAIN
• ICE BAG OR COLD PACK IS USED FOR AT LEAST
20 MINUTES.
• SWELLING IS MINIMIZED .
• COMPRESSION IS FOLLOWED BY CREPE
BANDAGE. ICE BAG CAN BE USED ALONG WITH
COMPRESSION ALSO.
• INITIALLY ICE CAN BE USED FOR A PERIOD OF
24 HOURS, BUT CAN BE EXTENDED UPTO 72
HOURS (DEPENDING UPON THE SEVERITY)
FOLLOWING INJURY.
• GRADUAL EXERCISES ARE STARTED AFTER 72
HOURS OF THE INJURY. ONCE SWELLING AND
PAIN SUBSIDES, PARTIAL WEIGHT BEARING CAN
BE STARTED.
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17. MUSCLE
CONTUSION
• COLD PACK IS USED FOR SUBSIDIZING
SWELLING AND TO REDUCE PAIN.
• ICE IS APPLIED FOR A PERIOD OF AT LEAST 20
MINUTES, AND RESPONSE IS SEEN.
• IF THERE IS REDUCTION IN SWELLING AND
HEMATOMA, IT CAN BE CONTINUED FOR
ANOTHER 20 MINUTES AFTER A INTERVAL OF
10 MINUTES.
• ASPIRATION OF HEMATOMA UNDER STRICT
STERILE CONDITIONS IS INDICATED IN
RECURRENT AND NONSUBSIDIZING
HEMATOMAS.
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18. THANK YOU
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